The impact on biochemical profiles and allograft function for patients converted from cyclosporine to tacrolimus after clinical heart transplantation.
OBJECTIVE
Tacrolimus, a potent calcineurin inhibitor, is a widely used immunosuppressant. This study sought to determine whether conversion from cyclosporine to tacrolimus afforded benefits on biochemical profiles and graft function among Chinese heart transplantation recipients.


METHODS
Forty-nine patients (44 men and 5 women) among 252 heart transplantations performed from 1995 to 2005 were converted from cyclosporine to tacrolimus due to rejection (69%) or to cyclosporine intolerance (31%). The median age of these recipients at transplantation was 46.4 years (range, 5 months to 68 years). Their median body weight was 60 kg (range, 4-84 kg). The allograft median ischemic time was 145 minutes (range, 52-300 minutes). We compared the biochemical markers, rejection episodes and allograft function.


RESULTS
The mean duration from heart transplantation to conversion was 419 days. After conversion, the serum bilirubin and alanine transaminase levels were significantly improved at 1 year. The lipid profiles, including triglycerides, total cholesterol, and low-density lipoprotein were nonsignificantly changed. The rejection episodes significantly decreased from 1.53 to 0.15 per patient per year (P < .001). The left ventricular ejection fraction significantly improved from 54.3 +/- 17.9% to 63.2 +/- 10.9% (P < .01). The right atrial pressure significantly decreased from 9.1 +/- 5.8 mmHg to 6.3 +/- 4.3 mm Hg (P < .01). The pulmonary capillary wedge pressure significantly decreased from 15.3 +/- 9.5 mm Hg to 10.8 +/- 5.3 mm Hg (P = .04).


CONCLUSIONS
In heart transplantation, conversion to tacrolimus owing to rejection or cyclosporine intolerance showed better liver profiles with fewer rejection episodes and improved graft function.
Wang
C H
CH
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Chou
N K
NK
Ko
W J
WJ
Chi
N H
NH
Tsao
C I
CI
Wang
S S
SS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation / Q000276:immunology / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D016559:Tacrolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous / Q000276:immunology / Q000502:physiology*
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D008055:Lipids; D016572:Cyclosporine; D003404:Creatinine; D000410:Alanine Transaminase; D001663:Bilirubin; D016559:Tacrolimus